Case study:
A 38 y/o man was suffering from severe chronic neck and upper back pain and stiffness. He reported that the level of pain in his neck was about 7/10 on a pain scale (o=no pain, 10=most pain) and in the upper body 5/10 on the same scale. Previously, when he had sought physical therapy treatment it helped for only a short period of time. The pain was debilitating and caused a lack of concentration, loss of work days and extra tension. After thorough evaluation, assessment revealed that he suffered from severe tension in the neck and upper body that was possibly caused from tension on the job, resulting in neck muscle spasm and decreased flexibility.
Plan of treatment was to combine Physical Therapy (PT), Guided Imagery (GI) and Movement Therapy (MT) to over come his disorder.
General goals with brief examples of the different approaches:
Our first steps were to further enhance chest and neck motion with PT and GI. For example, in GI, “allow yourself to imagine the neck being tilted to one side and then the other side with out actual movement of the affected area”. After these exercises the patient described feeling a bit looser. Then we elaborated on it by adding more imagery and physical exercises which did lead to a greater range of motion and flexibility.
It was important to increase his awareness and help him to establish the connection between social stress and neck tension. For example, when your boss speaks to you, what is happening in your neck area?. What do you feel and sense?. If someone else would speak to you what would you experience?. How does it manifest itself in the body?. He was asked to form a link between the external stimuli (harsh boss speaking to you) and the body reaction (neck erectors muscles tighten up). The patient then needed to practice and to continue to evaluate different everyday experiences and how they affect his neck and upper body.
There was an increasing awareness and ability to visualize other body parts connected to the neck and upper body. For example, in GI, the patient reported that he visualized a narrow tunnel between his chest and his head but that the head was disconnected from the chest. The goal was to establish a “normal” connection between all parts of his body. At later stage of his treatment, he was able to visualize the upper body and neck more fluidly connected to each other. We were trying to establish a flow of movement between all body parts to yield a more comfortable quality of motion by having the patient imagine water streaming up the tunnel without any blockages.
We wanted to evaluate and expand the breathing pattern by guiding movements and images between the chest and neck, chest and upper body, upper body and front of chest, belly and neck and belly and head. For example: breathing patterns were shallow between the chest and the other adjacent regions. In MT, patient was able to minimally mobilize the area. He described his feeling that it was stuck and stiff. Then he was stimulated to increase the area mobility in a gradual, safe manner done to music (the patient was a pianist who loved listening and moving to music). In GI, the patient described that forming a shield of light around his chest makes him feel stronger and safer. While practicing “building the shield” patient was able to use it for his benefit before important, stress inducing meetings at work.
Gradually the patient was able to feel his chest in a more substantial way as well as being more in touch with his entire being. When he entered a room he felt more present and noticeable by others. He felt as if he occupied a larger space than ever before. This improved his confidence level and his general rapport with co workers and friends. Additionally, he was able to speak more from his heart while using the imagery which included imagining warmth and strength radiating from his chest. He testifies that it was easier for him to work and deal with every day life challenges since his body and mind felt more integrated.
He reported the difference between how his co workers interacted with him before and after the creative imagery experiences as night and day. He could move forward better with every situation, discussing things and influencing decisions and people.
After 6 months of once or twice a week treatment patient was free of pain and stiffness. He was trained in many exercises and on follow up after 12 months he fully maintained his improved condition.
